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By: Alhag Abu Anzeh Muhammad (

Part A:

1. A 75 year old man with a history of myocardial infarction2 year ago, peripheral
vasclar disease with symptoms of cladication after half !loc", hypertension, and
dia!etes presents with a large ventral hernia, he wishes to have the hernia repaired.
#hich of the following is the most appropriate ne$t step in his preoperative wor"p%

a. A normal &'( precldes the need for frther cardiac testing.
!. )e shold ndergo an e$ercise stress test.
c. )e shold ndergo coronary artery !ypass prior to operative repair of his ventral hernia.
d. )e shold ndergo a presntative thallim stress test and echocardiography.
e.)is history of a myocardial infraction within 3 years is prohi!itive for elective srgery.*o frther testing isnecessary.

2. A victim of !lnt a!dominal trama ndergoes a partial hepatectomy. +ring srgery he receives twelve nits of
pac"ed red !lood cells. ,n the recovery room, he is noted to !e !leeding from intravenos pnctre sites and the
srgical incision. #hich of the following statements regarding the coaglopathy is most li"ely tre%

a. -he patient has an n"nown primary !leeding disorder.
!. -he coaglopathy is secondary to the partial hepatectomy
c. -he coaglopathy is secondary to delsional thromnocytopenia and deficiency of clotting
factors from the massive !lood transfsion.
d. -he treatment is oral vitamin .
e. -he treatment is intravenos vitamin ..

3. A /5 year old man has an enteroctaneos fistla originating in the 0e0nm secondary to inflammatory !owel
disease. #hich of the following wold !e most appropriate flid for replacement of his enteric losses%

a. +5#
!. 31 normal saline
c. 2inger lactate soltion
d. 0.31 sodim chloride
e. /1 sodim !icar!onate soltion

4. A 23 year old woman ndergoes total thyroidectomy for carcinoma of the thyroid gland. 5n the second
postoperative day, she !egins to complain of a tingling sensation in her hands. 6he appears 7ite an$ios and later
complains of mscle cramps. #hich of the following is the most appropriate initial management strategy%

a. 10 ml of 101 8agnesim slfate ,9
!. 5ral vitamin +
c. 100 micro gram oral synthroid
d. 'ontinos infsion of calcim glconate
e. 5ral calcim glconate.

5. A 24 year old firefighter sstains 301 total !ody srface area !rns to his torso, face, and e$tremities. )is wonds
are treated topically with silver nitrate. #hich of the following complications is associated with se of this agent%

a. )ypernatremia
!. 8eta!olic acidosis
c. )yperchloremia
d. *etropenia
e. )yponatremia

/. A 10 year old !oy was the !ac"seat !elted passenger in a high speed motor vehicle collision. 5n presentation to
the &2 he is awa"e, alert, and hemodynamically sta!le. )e is complaining of a!dominal pain and has an ecchymosis
on his anterior a!dominal wall where the seat!elt was located. #hich of the following statements is tre
regarding need for additional wor"p%

a.-he !oy can !e safely discharged home withot any other wor"p, since his a!dominal pain is
pro!a!ly secondary to his a!dominal wall ecchymosis.
!. -he !oy can !e safely discharged home if his amylase level is normal
c. -he !oy can !e safely discharged home if a!domen plain films are negative for the presence of free air.
d. -he !oy can !e safely discharged home if an a!dominal '- is negative
e. -he !oy shold !e o!served regardless of negative test reslt.

7. A patient is !roght to the &2 after a motor vehicle accident. )e is nconscios and
has a deep scalp laceration and one dilated ppil. )is heart rate is 120 !eats per minte !lood pressre is :0;40
mm;)g, and respiratory rate 35 per min. +espite rapid administration of 2 < normal saline, and patients vital signs do
not change significantly. #hich of the following is the most appropriate ne$t step in the wor"p of his hypotension%

a. *erosrgical consltation for emergent ventriclostomy to manage his intracranial pressre
!. *erosrgical conslation for emergent craniotoymy for sspected s!dral hematoma
c. &mergent !rr hole draining at the !edside for sspected epidral hematoma
d. Administration of mannitol and hyperventilation to treat his elevated intracranial pressre
e. A!dominal ltrasond =focsed assessment with sonography in trama, >A6-?

:. A 25 year old woman is diagnosed with !ilateral !reast 'A. sh ndergoes genetic testing to assess whether she
has a mtation in either @A2'A1 or @A2'A2. #hich of the following statements is tre regarding @A2'A mtation %

a. )er ris" as a woman nder the age of 40, for having a mtation in @A2'A1 or 2 is 401.
!. @A2'A1 tmors are more li"ely to !e estrogen recetor positive.
c. A mtation is @A2'A 2 is associated with an increased ris" of colon 'A.
d. A mtation in @A2'A 1 is associated with an increased ris" for pancreatic, !ile dct and gald!ladder 'A.
e.@oth @A2'A 1 and @A2'A 2are associated with an increased ris" of ovarian 'A !y age 70.

3. A 35 year old woman with a history of previos right thyroidectomy for a !enign thyroid nodle now ndergoes
completion thyroidectomy for a sspicios thyroid mass. 6everal hors postoperatively she develops progressive
swelling nder the incision, stridor and difficlty !reathing. 5rotracheal int!ation is sccessfl.
#hich of the following is the most appropriate ne$t step%

a. >i!eroptic laryngosopy to rle ot !ilateral vocal cord paralysis
!. Administration of ,9 calcim
c. Administration of !road spectrm anti!iotics and de!ridement of the wond
d. #ond e$ploration
e. Administration of high dose steroids and antihistamines.

10. A 15 year old otherwise healthy female high school stdent !egins to notice galactorrhea. A pregnancy
test is negative. #hich of the following is a fre7ently associated physical finding%

a. (onadal atrophy
!. @itemproal hemianopsia
c. &$ophthalmos and lid lag
d. &pisodic hypertension
e. @ffalo hmp

11. A 72 years old man stats post 'A@( 5 years ago present with hematocheAia,
a!dominal pain and fever. colonoscopy reveals ds"y appearing mcosa at splenic
fle$re withot active !leeding. which is the most appropriate manegment of this patient%

a. angiography with administration of intraBarterial papaverine
!. &mergent laprotomy
c. Aortomesenteric !ypass
d. &$ploratory laprotomy with -hrom!ectomy of the inferior mesenteric artery
e. &$pectant management

12. A 4/ years old women as" a!ot the need for srgery, since she was recently
diagnosed with 'rhonCs +isease. ,ndication for operation in 'hronCs inclde all e$cept:

a. ,ntestinal o!strction
!. &nterovesical fistla
c. Prolonged se of steroids
d. &nterovaginal fistla
e. >ree perforation

13. A2: years old women is 15 wee" pregnant, has new onset of nasea, vomiting and right sided a!dominal pain.
6he has !een free of nasea since early in her 1st trimester. the pain has !ecome worse over the past / hors. #hich
of the following statments a!ot appendicitis dring pregnancy is correct%

a.Appendicitis is the most prevalent e$tra terine indication for celiotomy dring pregnancy.
!.Appendicitis accre more commonly in pregnant women then in nonpregnant women.
c.6spected appendicitis in pregnant women shold !e manged with period of o!servation de to the ris"
of laprotomy to the fets.
d. *on complicated appendicitis reslt in 201 fetal mortality and prematre la!or rate.
e.-he sevirity of appendicitis correlates with increase gastational age of the fets.

14. A 41 years old men complains on regrgitation of saliva and ndigested food, an esophaogram reveals D!irds
!ea"D deformity. #hich of the following statments is tre a!ot the condition:

a. 'hest pain is common in advanced stage of the disease.
!. 8ore patients are improved !y forcefll dialatation then !y srgical intervention.
c. 8anometry can !e e$pected to show increase resting pressre of the <&6.
d. ,nitial srgical treatment consist primarily of resection of the distal esophags with reanastomosis
to the stoma a!ove the diaphragm.
e. Patients with this disease are at no increased ris" for the development of carcinoma.

15. A 72 years old men ndergo an aorto!ifemoral graft for symptomatic aortoiliac
occlsive disease. -he inferior mesenteric artery =,8A? is ligated at its aortic
attachment. 24 hors after srgery the patient has a!dominal distention, fever and
!loody diarrhea. #hich of the following is the most apropriate diagnostic stdy:

a. Aortogram
!. 82,
c. '-
d. 6igmoidoscopy
e. @arim enema

1/. A 3: years old women has 1.5cm mass in left @rest, clinical e$am reveals no sspicios adenopathy.
8ammogram gided !iopsy reveals infiltrating dctal carcinoma. -he patient prefer lmpectomy followed
!y radiation. #hich of the following statements a!ot sentinel lymph node is tre%

a. it is only indicated in clinically E a$illa
!. it is associated with srvival advantage over rotine a$illary dissection .
c. neoad0vant chemotherapy does not affect relia!ility of 6<*@.
d. it is !est preformed with !le dye alone.
e. it is not indicated !ecase of her premenopasal state.

17. Postmenopasal women choose mastectomy and sentinel lymph node !iopsy
=6<*@? for a new diagnosed @rest carcinoma. >inal pathology reveals 1cm infiltrating dctal carcinoma with
negative 6<*. ,t is estrogen receptor;progesterone receptor =&2;P2? positive and )&22;ne negative
-he most appropriate ad0vant therapy wold !e:

a. aromatase inhi!itor
!. tamo$ifen
c. postoperative @rest radiation therapy
d. prophylactic oophorectomy
e. cytoto$ic chemotherapy

1:. 3: years old women with right colon cancer, her history meet Amsterdam criteria, also has a 10 years old son.
#hich of the following statements is tre%

a. son shold !egin colonoscopy at age 10B12 years.
!. son shold have colonoscopy every 5 years.
c. son have 251 ris" of receiving the mtation.
d. tmor shold !e tested for microsatelite insta!ility.
e. patient shold have right hemicolectomy

13. 55 years old with 1st episode of diverticlitis, hemodynamicaly sta!le and improve within 4:h receiving
anti!iotic and nothing !y moth. '- show stranding of sigmoid mesentery, !t no free air evidence of an a!scess.
-he ne$t step shold !e:

a. resection and anastomosis
!. resection and colostomy
c. discharge E elective colectomy
d. discharge E oral anti!iotic
e. colonoscopic intralminal stench

20. 40 years old women, history of chronCs disease and many prior small !owel
resections, present with intracta!le non !loody diarrhea, weight loss and several recent
admissions for vol depletion and electrolyte distr!ance. -he most li"ely diagnosis:

a. recrrence of active 'hronCs
!. short !owel syndrome
c. chronic renal insfficiency
d. vills adenoma of rectm
e. inf. (astroenteritis

21. A 4: years old man with a history of alcohol se presents evalation reveals a
linear disrption of the gastric mcosa high on the lasser crvatre at the gastroesophageal 0nction.&ndoscopic
attempts to control the !leeding fail. -he patient has received / nits of pac"ed 2@'s and his heart rate is115;min
with a systolic !lood pressre of :5mm)g. -he most appropriate management wold !e:

a. &m!oliAation of the left gastric artery
!. placement of a 6engsta"enB@la"emore t!e with inflation of gastric !alloon
c. Anterior gastrotomy and eversewing of the !leeding site.
d. Antrectomy ,vagotomy,and !iopsy of the !leeding site.
e. -otal gastrectomy

22. A 51 years old man with a history of peptic lcer disease presents with a!dominal pain and free air.dring
operation a dodenal perforation is identified with significant associated peritonitis .A modified (raham patch is
performed.Acid redction therapy is initiatedand serology for )elico!acter pylori is o! days after
operation an operativedrain !egins draining copios amonts of !ile.8anagement of this dodenal fistla incldes all
of the following e$cept:

a. cholestyramine
!. total parenteral ntrition
c. somatostatin enteral ntrition
d. *aso0e0nal enteral ntrition
e. @ile reBfeeding

23. A 75 years old woman presents with the acte onest of a!dominal pain . on
physical e$amination ,she has a palpa!le a!dominal mass that is painfl with
contractre of the a!dominal mscles. 6he has no peritoneal irritation .she is receiving anticoaglation for recent
onest atrial fi!rillation . the nderlying vessel casing this pro!lem is most li"ely the:

a. ,nferior epigastric artery
!. 6perior mesenteric arery
c. 6plenic artery
d. 6perior mesentric vein
e. <eft gastroepiploic artery

24. 6i$ months after laparoscopic splenectomy for immne throm!ocytopenic prpra ,a 3: years old woman with
lps remains throm!ocytopenic =platlet cont42,000 cell;mmF3?. -he ne$t step shold !e:

a. platlet transfsions
!. &valation for accessory spleen
c. Plasmapheresis
d. @one marrow !iopsy
e. 2eBlaparoscopy

25. A 20 years old man has a 2 cm right adrenal mass fond dring a wor" p for low !ac" pain.the left adrenal is
of normal siAe .the ne$t step shold !e:

a. 2epeat imaging stdy in / months
!. 24 Bhor rinecolection for catecholamines
c. '- B gided fine Bneedle aspiration
d. high Bdose de$amethasone test
e. &lective right laparoscopic adrenalectomy

2/. A 5/ years old postmenopasal woman has serim calcim of 10.3 mg;dl =normal 7.5 to 3.5? and a serm P-) of
:5 pg;ml=normal 20 to /0 pg;ml? . 6he has no family history and is asymptomatic .she is an avid 0ogger . @one
densitometry =+&GA scan? shows minimal osteoporosis. #hich of the following is tre%

a. 'alcim spplementation will decrease her ris" of stress factre.
!. the *,) consenss conference recommends o!servation
c. 24 Bhor rine collection for calcim will !e diagnostic
d. she is a candidate for parathyroidectomy
e. treatment with !iphosphonates is warranted

27. A 44 years old woman has papillary thyroid carcinoma of the right lo!e confirmed !y fineBneedle aspiration.
Hltrasond stdy stages the tmor as -1 =1.5 '8?. 5ptimal srgical management wold !e:

a. 2ight thyroidlo!ectomy , selective mode dissection of the right side
!. 2ight thyroidlo!ectomy, level 9, =central compartment? nod dissection
c. -otal thyroidectomy, selective dissection on the right side
d. -otal thyroidectomy, level 9, dissection and selective dissection of the right side
e. -otal thyroidectomy

2:. #hich of the following is the most sefl in identifying patients at high ris" for familial medllary thyroid cancer%

a. 2&- oncogene
!. calcitonin levels
c. calcim levels
d. .Bras oncogene
e. Hrine metanephrines.

23. A!normalities in all of the following varia!les have !een sed to sggest the need for damage control
=or a!!reviated? laparotomy in trama patients e$cept :

a. -emperatre
!. P)
c. @ase deficit
d. Prothrom!in time
e. Platelet cont

30. A 3/ years old man has a !lood pressre of 70;40 mm;)g after a motor vehicle
crash .resscitation is initiated. >ocsed assessment with sonography for trama
=>A6-? is positive for flid in the a!domen. on e$amination of the pelvis ,fractre B
related crepits and an enlarging perineal hematoma are appreciated .the patients
!lood pressre does not improve with ressciatation .the ne$t step in management shold !e:

a. '- of the a!domen and pelvis
!. +iagnostic peritoneal lavage
c. Placement of an e$ternal pelvic fi$ator
d. &$ploratory laparotomy
e. pelvic angioem!oliAation

31. 3: y.old woman shold go laparoscopic cholicystectomy, no family history of throm!oem!olic events and
no personal medical history of throm!oem!olic events. #hich is indicated for perioperative +9- prophyla$is%

a. no prophyla$is is needed
!. se7ential compression
c.s!ctanes nfrictioneted heparin
d. s!ctaneos <8#)
e. se7ential compression device and s!ctaneos nfrictionated heparin

32. Preoperative !iochemical evalation of patient for parathyroidectomy is dne for P)P- =primary
hyperparathyroidism? show 'aE 12 and intact P-) =200pg;ml?. 1cm hypercelllar parathyroide adenoma is
resected . Postoperatively the patient complaint on perioral tingling, nm!ness and carpopedal spasm.
-he &'( will show:

a. atrial fi!rillation
!. prolong I-
c. pec"ed - wave
d. torsa des pointes
e. H wave

33.'ommon complication of 2J(@:

a. vitamin + deficiency
!. primary hyperparathyroidism
c. anemia de to lac" of transferin
d. symptomatic thyamin deficiency

34. /0y.o. man completed chemotherapy for hepatic metastasis related to colorectal
cancer #@' 1200, fever 33c, diffsed a!dominal pain. '- of the a!domen and pelvic show inflammation and
thic"ening of the ilim, cecm and right colon. 8ost li"ely diagnosis is:

a. clostridim difficilis colitis
!. netropenic enterocolitis
c. to$ic megacolon
d. lcerative colitis
e. colon psedoo!straction

35. 1: year old men went inginal hernia reaper with spinal anesthesia. #hat is correct regarding preoperative:

a. oral ceforal on the morning of the srgery
!.oral ceforal in the evening !e for the srgery
c. no preoperative is needed
d. 40mg cle$an evening !e for the srgery

3/. ::y.old man has sever inginal pain. 2 wee"s ago he had acte 8.,. and since than sing aspirin, on e$amination
he has pain, no fever, heart rate 115, a!domen is not distended, no peritonitis. ,ncancerated no redci!le right
inginal hernia is fond. -he most appropriate ne$t step will !e:

a. rgent cardiac catheteriAation
!. e$ercise thalim
c. srgical hernia repaire
d. hernia redction attempt nder deep sedation
e. '- of the a!domen and pelvic
37. 6mall !owl o!strction from !eAoar is more common after:

a. colon resection de to cancer
!. !ariatric srgery
c. vagotomy
d. mltiple a!dominal srgery

3:. All are compensatory mechanism in hypovolemic shoc" e$cept:

a. increased peripherial resistance secondary to increase catecholamine level
!. increase +P( 2,3
c. right shift of hemoglo!in dissociation crve to acidosis
d. decrease cardiac contractility

33. 2ecommended to colorectal liver metastasis that localiAed to one liver lo!e is:

a. lo!ectomy of the lo!e which containing the metastasis
!. lo!ectomy of the lo!e which containing the metastasis and systemic chemotherapy
c. systemic chemotherapy with cytoto$ic and !iologic drg
d. palliative treatment only

40. A 55y.old woman no history evalation for melena has 2cm (,6- =gastrointestinal stromal tmor? in the anterior
wall of the stomach. -he diagnosis confirmed !y immnohistochemical, no evidence for ad0acent organ invasion or
metastasis. -he recommended treatment is:

a. s!total gastrectomy and regional lymph node dissection
!. give tyrosin "inase inhi!itor =imatini!? till complete response and offer srgery if medical treatment is fail
c. open or laparoscopic margin free tmor e$cision and fallow p
d. only imatini! treatment

41. ,n the &2, /0 yearBold male with no previos medical history is fond to have an o!strcting tmor in the
sigmoid colon on com!ined '- and gastrografin enema , no distant metasteses are identified and the cecmCs
diameter is 15 cm. #hat is the recommended treatment%

a. mecchanic !owel preparation followed !y srgery that incldes sigmoidectomy, regional lymph node dissection,
and anastomosis.
!. !.immediate srgery that incldes sigmoidectomy, regional lymph node dissection, and anastomosis
with no frther wor"Bp.
c. immediate colonscopy with !iopsy and after the diagnosis is histologically confirmed, sigmidectomy, regional
lymph node dissection, and creation of pro$imal stoma=)artman resection?.
d.immediate srgery that incldes sigmoidectomy,regional lymph node dissection, and creation of pro$imal stoma.

42. A cirrotic patient that is a liver transplant candidate is admitted for esophageal !leeding varices .
-reatment with somatostatin and endoscopy inclding sclerotherapy and failed !anding donCt stop the !leeding.
#hat is the ne$t step%

a. -,P6
!. repeat endoscopy
c. distal splenorenal shnt
d. srgical procedre =portoBaAygos disconnection?.

43. A 45 yearBold man with a history of chronic peptic lcer disease ndergoes a trncal vagotomy and antrectomy
with a @illroth ll reconstrction for gastric otlet o!strction. / wee"s after srgery, he retrns , complaining of
postprandial wea"ness, sweating ,lightheadedness, crampy a!dominal pain and diarrhea.
#hich of the following wold !e the !est initial management strategy%

a. treatment with a long acting somatostatin analog.
!. dietery advice and conseling that symptoms will pro!a!ly a!ate within 3 months of srgery.
c. dietery advice and conseling that symptoms will pro!a!ly not a!ate !t arenCt dangeros.
d. wor"Bp for neroendocrine tmor=carcinoid?.
e. preparation for revision to 2o$BenBJ gastro0e0nostomy.

44. A 5: yearBold man with a mass in the left side of his nec". -he patient noticed the mass several wee"s ago, and
was given anti!iotic !y his primary care physician. -he mass appeared to s!side somewhat, !t is still present. H.6.
shows a 2 cm solid mass. 5n e$amination, the mass is 2 cm, firm and fi$ed to the nderlying tisse.
-he !est step now wold !e:

a. color flow +oppler
!. '- of the head and the nec".
c. 82, of the head and the nec".
d. >ineBnedeel aspiration of the mass.
e. srgical !iopsy.

45. 14 yearBold girl with a si$ month history of sdden , rapid ,asymmetric enlargement of the right !reast. 5n
physical e$amination, there is a large palpa!le mass occpying the !reast with mar"ed nippleB
areolar stretching, prominent dilated veins, and s"in lceration. 8ammography and H6 show a
dense, wellBcircmscri!ed 7 cm homogenos mass occpying the left !reast. -he most li"ely diagnosis is %

a. invasive dctal carcinoma
!. hemangioma
c. giant fi!roadenoma
d. 0venile !reast hypertrophy
e. phyllodes tmor

4/. a 51 yearBold !lond, light ,comple$ioned man had ndergone laparotomy for progressive small !owel
o!strction. A desmoplastic reaction is casing this small !owel o!strction. #hich of the following !est
descri!es the diagnosis%

a. lymphoma
!. carcinoid
c. (,6- =leiomyosarcoma?
d. melanoma
e. primary small !owel adenocarcinoma

47. #hich of the following statements a!ot laparoscopic 2o$BenBJ gastric !ypass
=2J(@? compared with laparoscopic ad0sta!le gastric !anding =A(@? is not tre%

a. !oth decrease long term mortality compared with controls.
!. A(@ has lower perioperative.
c. 2J(@ is associated with higher ris" of iron deficiency anemia.
d. A(@ is associated with fewer internal hernias.
e. A(@ is associated with more sstaina!le longBterm weight loss.

4:. )erediatry spherocytosis:

a. necessitates splenectomy for all patients with the diagnosis.
!. reslts in a loss of spherocytes on the peripheral smear after splenectomy .
c. is associated with increased red cell fragility.
d. reslts in splenic infarction.
e. is cased !y a defected in the !ilayer of the cell mem!rane.

43. A /4 yearBold man has a solitary thyroid nodle discovered dring a screening
carotid dple$. >ineBnedeel aspiration of the nodle shows a predominance of )rthle cells with scant amonts of
colloid and no evidence of malignancy. the ne$t step shold !e:

a. total thyroidectomy
!. repeat !iopsy in / months.
c. thyroid sppression therapy.
d. hemithyroidectomy with isthmsectomy.
e. total thyroidectomy with central node dissection.

50. A healthy 3: woman is resced from a hose fire after 20 emergency department, she has an anterior
chest !rn and is wea", confsed and lethargic. the most li"ely diagnosis is:

a. '5 and pelvis.
!. inhalation lng in0ry.
c. hyperca!ic respiratory failre.
d. pnemothora$.
e. pper airway o!strction.

51. 31 year old (2P1, 33 wee"s complains on a!dominal pain, her terine contraction recorder every 3B4 min, her
cervi$ changed only 1 to 2 cm in diameter in over 3 hors. #hich of the following management of the patient%

a. 'B section
!. ,9 o$ytocin
c. 5!server
d. >etal scalp P) monitoring
e. ,ntra nasal gonadotropine

52. #hich of the following placental implantation most li"e predisposed to inverted terine in 3rd stage of la!or%

!. Anterior
c. Posterior
d. <ateral
e. <m!ar stage of la!or

53. 23 year old (2P1 delivering 42 wee"s gestational, is noted to !e in second stage when fets head is retracted
!ac" to the introits. -he sholder is not deliver with the psh of the mother. #hich of the following manevered
is !est%

a. ,nternal podalic version
!. 6pra!!ic pressre
c. >ndal pressre
d. ,ntentional fractre of the hmers
e. +elivery of the anterior scalp
54. 33 year old in 23 wee"s of gestation hers !lood pressre is 150;30, proteinrea E2,
platelets and liver enAyme are in the normal range. #hich @&6- management of patient%

a. ,ndction of liver
!. 'B section
c. Antihypertensive therapy
d. &$pected management
e. 8agnesim slfate

55. 13 year 2: wee"s of gestation complain of intermediate a!dominal pain. 5n cardiotocography the terine
contraction 3B5 min, cervi$ 3cm dilation, with 301 effacement. >etal verte$ presentation at spinal 1 station.
#hich most li"ely to !e contraindication for tocolytic%

a.6spected placental a!rption
!. (rop @ streptococci
c. 2ecent elective laparotomy
d. Hterine s! seros fi!roid
e. -he crrent stats

5/. #hich of following most potent natral estrogen%

a. &sterone
!. &stroadiol
c. &striol
d. &thinyl estradiol
e. Phytoestrogens

57. #hich of the following change in nasal !one have for +own syndrome in H6%

a. A!sent
!. ,ncrease in siAe
c. +ecrease in siAe
d. ,ncrease in opacitaiton
e. +ecrease in opacitation

5:. Jo are monitoring patient contraction pttern, dring 20 min she has / e7ally
contraction. @ase line teine tone is 10 mm)g and pea" intensity of each contraction
reaches 50 mm)g. #hich following nm!er of 8ontevideo nits define this activity%

a. 120
!. 150
c. 240
d. 300
e. 3/0

53. #hat is the most common side effect of intrapartm epidral Anastasia%

a. ,ncrease in !lood pressre
!. +ecreases in !lood pressre
c. '*6 stimlation
d. ,neffective !lac"en
e. '6> lea"

/0. >orceps application when fetal head =left occipital anteroBposterior? has reached the pelvic floor is at partm
classier at what type delivery%

a. 5tlet forceps
!. <ow forceps
c. 8id forceps
d. )igh forceps
e. *on of a!ove

/1. -he !est pregnancy management of a 40 years old nllipara, prior myomectomy dring which the endometrial
cavity was anterior:

a. <a!or allowed
!. <a!or allow, low forceps;vacm to shorten the 2sd stage
c. 'aesarian section near prior term of la!or
d. 5$ito$in at 3: wee"s
e. 'aesarian section at 40B41 wee"

/2. 8ost common pathogen associated with intra terine growth restriction:

a. 2!ella
!. 9aricella Aoster
c. ,nflenAa
d. 'ytomegalovirs
e. Parvovirs

/3. A cople, diagnosed as primary infertility 2 year old, in sperm cont K sever
5ligo-eratoAstheno6permia. 8ost appropriate ne$t diagnostic test:

a. 2epeat sperm cont in 1B3 month
!. 8ale !lood "aryotype
c. 8ale fll hormonal profile
d. Prolactin E thyroid fnction
d. J chromosome deficiency

/4. A 30 years old male, diagnosed as non o!strctive aAospermia, small testicle, lac" of facial and p!ic hair and
gynecomastia. 8ost pro!a!le hormonal stats :

a. )igh <), high >6), low testosterone
!. <ow <), low >6), low testosterone
c . )igh <), low >6), high testosterone
d. )igh <), high >6), high testosterone
e. )igh <), low >6), high testosterone

/5. -re regarding the difference !etween water and fat sol!le contrast media for performing

a. 'hance of pregnancy increase with water sol!le compare to fat sol!le
!. 'hance of pregnancy increase with fat sol!le compare to water sol!le
c. Hterine strctre is !etter otlined with water sol!le
d. 2is" of granloma is decrease with fat sol!le
e. A!dominal pain slightly increase with water sol!le

//. A cople is diagnosed with ne$plained infertility, what is not correct:

a. :01 chance of pregnancy in 3 years withot treatment.
!. ,9> is the primary treatment of choice.
c. 5vlation indction with gonadotropine is a treatment option
d. ,ntraBterine insemination after washing is a treatment option
e. ,9> is an option if other treatments have failed.

/7. #hich of the follow case primary amenorrhea%

a. Prematre ovarian failre
!. Pregnancy
c. .allman syndrome
d. 6heehan syndrome
e. Asherman syndrome

/:. #hich can reslt amenorrhea%

a. Arcate ncles in0ry
!. 5lfactory nerve in0ry
c. Post )ypophisis in0ry
d. 8edioBlateral )ypophisis in0ry
e. Prolactine deficiency

/3. #hich of the follow characteriAes syndrome "nown as Lfemale athletic -riadM:

a. Period !leeding in response to progesterone treatment
!. ,ncrease in over 101 in ideal mscle mass
c. )ypophisis atrophy
d. 5steopenia
e. )irstism

70. ,n which of following will differentiation to female Phenotype occr%

a. +eficiency at chromosome J long arm
!. 45 G0 "aryotype
c. A8) gene mtation
d. 47 GGJ
e. 47 GJJ

71. A 25 y;o female is !een evalated for infertility with reglar periods. #hich of the following confirms the
e$istence of ovlation%

a. progesterone level N5ng;ml
!. proliferative histology in endometrial !iopsy in the lteal phase viscos
c. cervical mcs
d. increase in corporal temperatre after the menstral period
e. increase in <) and decrease in progesterone in the lteal phase

72. #hich one of this ovaric tmors doesnOt prodce hirstism%

a. sertoliBleydig tmor
!. donOt remem!er
c. 7istic teratoma
d. gonado!lastoma
e. lteoma

73. #omen with 50 y;o menopasic with ovaric insfficiency in treatment with ovm
donation, which of the following precations for the implantation of the fets is correct%

a. estrogen E progesterone en el comienAo de la menstracion
!. she doesnOt need preparation of the terin mcs
c. preparation of estrogen and A++ progesterone 2 wee"s later
d. stop the hormonal spport after implantation
e. the nm!er of implanted fets is associated with the age of the donor

74. A 3: y;o patient who since the last 2 years has !een !leeding for more that 3 days in every period. 6he has
periods every 32 days and no !leeding !etween periods. #hat is the !est nest step to do%

a. coaglation test
!. lhand test
c. endometrial !iopsy
d. pelvis ecografy
e. -6) test

75. #hich of the follows doesnOt prodce hirstism%

a. 5 alfa redctase deficit
!. 21 hidro$ilase
c. ovaric aromatase deficit
d. 11 hidro$ilase deficit
e. donOt remem!er

7/. A 43 y;o with myomatosis and vaginal !leeding !etween the periods and in the periods, with periods every
5B/ wee"s that lasts from / to 10 days. #hich the ne$t management to do%

a. (*2) agonists for 3 months
!. (*2) for / months E hormones
c. histerectomia
d. endometrial !iopsy
e. a!lation

77. A 23 y;o woman with a!dominal pain that intensifies dring periods. 6he on !irth control pills, !ecase of the
pain she goes to laparoscopy where they find where they see lesions of endometriosis and they treat it with laser.
#hat is the ne$t step of the treatment in this patient%

a. contine with !irth control pills
!. (*2) agonists for / months
c. aromatase E !irth control pills
d. total hysterectomy E !ilateral salpingooforectomy
e. danaAol
7:. A 24 y;o patient with no children presents with vaginal !leeding. 6he has a pregnancy !y @)'( of 3500 mH,;ml
with normal vital signs, with an ecogafy that doesnOt show a gestational sac !t shows a mass of 3.2 cm in the rifht
adne$al. #hich of the following is the !est treatment for this patient%

a. o!servation
!. metotre$ate ,8
c. laparoscopic salpingectomy
d. laparotomy salpingectomy
e. laparoscopic salpingectomy

73. ,n the pelvic inflammatory disease yo need to diagnose and treat early to prevent which of the following%

a. pelvic paint 6+
!. infertility
c. ectopic pregnancy
d. t!oovaric a!scess
e. adhesion

:0. A 35 y;o woman nlliparos who has hemoptysis. 6he has a history of a!ortion 3 months ago and now has a
@)'( of 35000. 5n the thora$ G ray there is a mass in the middle lo!e of the right lng.
#hich is the !est initial treatment in this patient%

a. lavage and crettage
!. histerectomy
c. methotre$ate and lecovirine
d. actinomicine
e. metotre$ate E actinomicine E etoposide

:1. #hich of the following is correct regarding intraterine device%

a. the ris" of P,+ increases with the se dration.
!. the ris" of P,+ increases dring the first month after insertion.
c. the a!salte ris" for infection with protes vaginalis is common.
d. CCmirenaCC device contains medro$yBprogesterone.
e. ris" for ectopic pregnancy is increased.

:2. #hich of the following is correct regarding progesteroneBonly oral contraceptives%

a. cervical mcs viscosity is decreased
!. it is more effective than other oral contraciptives.
c. there are <) !t no >6) srges dring treatment.
d. there are >6) !t no <) srges dring treatment.
e. mood and li!ido are improved.

:3. #hich of the following stataments concerning sage of com!ined oral contraceptives and cancer is tre%

a. sage of com!ined oral contraceptives increases the prevalence of ovarian carcinoma
!. sage of com!ined oral contraceptives protects from endometrialn carcinoma
c. sage of com!ined oral contraceptives protects from !reast cancer
d. sage of com!ined oral contraceptives protects from cervical carcinoma
e. sage of com!ined oral contraceptives increases the prevalence of gastric carcinoma

:4. #hich of the following tisses is not rotinely resected dring radical hysterectomy for s7amos cell carcinoma of
the terine cervi$%

a. parametrim.
!. socroBterine ligamints.
c. ovaries and fallopian t!es.
d. pelvic lymph nodes.
e. vaginal dome.

:5. #hich of the following is ni7e in ovarian endodermal sins tmor%

a. estrogen secretion.
!. androgen secretion.
c. lymphocytic infiltration.
d. neroectodermal tisse.
e. schillerBdval !ody.

:/. A laparoscopy is done to an 1: years old female with peritonitis, it shows rptre and !leeding of a 10 cm cyst
that encompasses the entire left ovary. +ysgerminoma is diagnosed on froAen section !iopsy. 'orrect treatment:

a. 5ophorectomy of the involved ovary.
!. >ll staging inclding hysterectomy, oophorectomy lymph node !iopsy.
c. 'hemotherapyEcar!oplatineEta$ol.
d. @rachytherapy of left pelvis.
e.2esection of involved ovary and resection of the other ovary with cryoB preservation to maintain fertility.

:7. A 54 year old male complains of dyspnea for : months. )e has minimal prior medical care, non prior
pro!lems and denise ta"ing any medications. )e smo"es 1 pac"age of cirgarrets for the last 30 years.
5n physical e$amination sta!le prolonged e$piratory phase an diminished !reath sonds !ilaterally. -he
most li"ely case of this chronic dyspnea:

a. Plmonary em!olism.
!. '5P+.
c. +8
d. 8,
e. Pnemonia.

::. An 40 y old male presents with painfl, swollen right "nee and low temperatre. -he most sefl test is:

a. 'omplete !lood cont.
!. Hric acid level in !lood.
c. &62.
d. 2hematic factor.
e. Point flid analysis.

:3. A previosly healthy 2/ year old male complained of a!dominal crsmps for the past 2 days.<oose stool in a
24h stool specimen reveals presence of !lood and #@'. -he most li"ely diagnosisQ

a. 6tasphylococs food poisoning.
!. 2otavirs.
c. 'rohnOs disease.
d. 6higellosis.
e. ,rrati!al !owel syndrome.
30. A 7/ year old male complains of progressive worse fatige over the past / months, difficlt in wal"ing 2 !loc"s
and poor appetite and loose of 15 "g. Physical e$amination shows pale con0nctiva, clear lngs !ilaterally, )2: reglar
3/!pm, no mrmrs. '*' hemoglo!in 7g1 and decreased 8'9. ,ncrease in total iron !inding capacity and low
ferritin. Anemia is most li"ely de to secondary:

a. -thalassemia.
!. Anemia of chronic disease.
c. >olate deficiency.
d. 9itamin @12 deficiency.
e. ,ron deficiency anemia.

31. /0 yRo woman compalins of fatige for / month. 'ondition worsens progresivly.
now she !egins to notice wea"ness and nsterdiness in her gate. 5n e$amination: pale
con0nctiva, heartR lngs normal. 5n nerological e$amination:decreased vi!ratory
sense. )g!: : 8'9is increased. -he most common case of this condition is:

a. a.iron deficiancy
!. !.folate deficiancy
c. c.pernicios anemia
d. d.anemia of chronic disease thalassemia

32. A Patient is diagnosed with (raveCs disease. #hat wold !e the findings%

a. low -6) and high free -4
!. )ot nodleDon a thyroid scan
c. Anti!odies for -hyroid
d. )igh -6) S >ree -4
e. >ine needle aspiration !iopsy is necessary.

33. 40 year old female patient is presented with left chest pain. the pain is located mid claviclar on the 4th
intercostal space. -here is a trigger point and the pain is increased with inspiration. #hat is the most li"ely diagnosis%

c. chostochondritis

34. A /: year old woman comes to discss reslt of her dalBenergy $Bray
a!sorptiometry =+&GA? scan. )er -Bscore is 2.7 in spine femr. yo e$plain that she has osteoporosis and re7ires
treatment management of osteoporosis incldes:

a. +aily inta"e of 500 mg calcim.
!. avoidance of weightB!earing e$ercise.
c. -a"e !isphosphonates on a fll stomach.
d. stop smo"ing.
e. monthly se of newly formlates !isphosphonates.

35. /0 yRo woman presents with chronic dyspnea and a long history of smo"ing. yo diagnose '5P+ and treat to
relieve the symptoms. ,n addition to this therapy, other recomandetion mst inclde:

a. spiral '- of chest
!.e$ercise avoidance
c.stop smo"ing
d.)aemophil inflenAa ! vaccination
e.refer to !ronchoscopy.
3/. 45 yRo healthy male come for physical e$amination. )is last e$amination was 10
years ago and was normal. *o history, no medication, no smo"ing, drin"s 2B3 alcoholic drin"s wee"ly. >amily history is
positive for hypertension from the maternal side. -he patient has no physical complains. )is eamination is normal,
!t, the @P is 14:R3:. Jo recomend rechec" of @P in 1 month and @P is 150R100. >rther evalation shold inclde:

a.serm and rine chatecholamine
!.cardiac stress test
c.&'( test
e.renal scan

37. 20 yRo woman with concerns that her thyroid is overactive. !ecase her mother has similar condition and she has
not !een feeling well. in evalating this patient, what wold strongly sggest hyperthyroidism%

a. palpitations
!.increased weight
c. constipation

3:. 2/ yRo man arrives to the &2 with complaints of acte onset of the Dworse headache of my lifeD. Appropriate
diagnostic evalation. -reatment wold inclde:

a.smatriptan /mg s!ctanos
!.head '- and if negative <P
c. head '-
d. i!profen /00mg per os every / hors
e.&62 test and while awaiting reslts corticosteroid therapy.

33. /: yRo man presents for a rotinly physical e$amination. in addition to o!vios history and e$amination, which
one of the following wold !e rotinly reccomended%

a.chest GB2ay
!. )@9 vaccination
c.+&GA scan
d.pnemoccocal vaccination

100. 42 yRo woman retrnes from a !isness trip and notes the sdden onset of
dyspnea with pleritic right sided chest pain. 8edical history is nremar"a!le, she is crrently se oral
contraceptives. 9ital signs: @P120R70, )2100, 2224 and reglar. temp 37'. )eart and lngs are nremar"a!le, no
chest wall tenderness, no cyanosisRcl!!ing of the e$trematies, !t, pitting edema in her right leg.
testing shold !e done promptly to e$clde the following:!romyalgia
c. plmonary em!oli
e.vericose veins

101. A 50 yearBold man complain of recrrent chest pain that radiates down his left arm and has !een occrring
over the past 3 months.-he pain is descri!ed as a retrosternal pressre. ,t is !roght on !y wal"ing or other
strenos e$ercise and is relieved !y 2 mintes at rest.
)is vital signs are sta!le and the physical e$amination is nremar"a!le. -he most li"ely diagnosis:

a. myocardial infarction
!. sta!le angina
c. nsta!le angina
d. pericarditis
e. plerisy

102. 5f the following conditions, wich is related to the development of osteoporosis in men%

a. prolactinoma
!. hypogonadism
c. prostate cancer
d?renal stones
e. inginal hernia

103. A /5 year old with a history of chronic atrial fi!rillation in !eing monitored while warfarin therapy. -he nrse
calls to inform yo the patientMs ,*2 is measred at 7. )e has no active signs of !leeding.!t manangment at this
time incldes:

a. stop warfarin,o!serve and repeat ,*2 in 3 days
!. stop warfarin and o!serve,repeat ,*2 in 24 hor
c. stop warfarin,give vitamin . and repeat ,*2 in 24 hor
d. stop warfarin,give vitamin . and fresh froAen plasma with daily ,*2

104.#hen is a comprehensive evalation necessary when a patient is affected !y deep vein throm!osis =+9-?:

a. 45 yearBold male with an idiopatic +9-
!. /5 yearBold with a recent transatlantic flight and +9- of the left thigh
c. 55 yearBold who develops a calf +9- after a 4 hor car ride
d. 75 yearBold with a history of nonBsmall cell lng cancer with left leg +9-
e. 72 yearBold with a right thight +9- and no history of travel

105. Anemia that is scan in patient with chronic renal disease is sally cased !y insfficient:

a. ,ron stores
!. vitamin @12
c. renin levels
d. erythropoietin levels
e. folat st

10/. ,ron deficiency anemia is associated with:

a. hyperchromic , macrocytic featres.
!. elevated serm iron levels.
c. increased total ironB!inding capacity =ti!c?.
d. increased ferritin levels.
e. normal !one marrow !iopsy reslts.

107. #hich of the following &'( findings is associated with sdden cardiac death:

a. prolonged I- interval.
!. firstBdegree A9 !loc".
c. sins arrhythmia.
d. right !ndle !ranch !loc".
e. prematre ventriclar contractions.

10:. -he !est medication to se in the emergent treatment of spraventriclar tachycardia is:

a. digo$in.
!. verapamil.
c. adenosine.
d. diltiaAem.
e. isoproterenol.

103. -reatment of a severely infected dia!etic foot lcers shold involve:

a. topical anti!iotics.
!. de!ridement only.
c. de!ridement with systemic anti!iotics.
d. de!ridement with topical anti!iotics.
e. none of the a!ove.

110. A 41 year old !siness e$ective presents to yor office and complains of palpitations and shortness of !reath.
After frther 7estioning, he admits to heavy alcohol consmption the previos evening. 5n e$amination, he is fond
to have an irreglar heart!eat of 130 !eats per minte. -he most li"ely diagnosis is:

a. ventriclar tachycardia.
!. ventriclar fi!rillation.
c. prematre ventriclar contractions.
d. atrial fi!rillation.
e. wolffBpar"insonBwhite syndrome.

Part @:

1. A 3/ years old woman with 6<& presents with acte onset of lethargy and 0andice.
5n initial evalation, she is tachycardic, hypotensive, pale, dyspneic and is difficlt to
arose. 5n physical e$amination: splenomegaly. ,nitial )! / g;dl, #@' B /300;, P<-
B 234 000;, total !ilir!in B 4 g;dl. 2eticlocytes B 1:1, haptoglo!in is not detecta!le,
normal renal fnction and normal rinalysis. #hat wold e$pect in peripheral !lood smear:

a. 8acrocytosis and P8* with hypersigmented nclei.
!. 8icrospherocytes
c. 6chistocytes
d. 6ic"le cells

2. A healthy /2 years old woman retrns to yor clinic after a rotine colonoscopy. #ere fond two 1.3 cm
sessile =flatB !ased? villos adenomas in ascending colon, which were removed completely dring the procedre.
*e$t step:

a. 'olonoscopy B 3 month
!. 'olonoscopy B 3 years
c. 'olonoscopy B 10 years
d. '- scan of the a!domen
e. Partial colectomy

3. #hich of the following shold promt investigation for the hereditary nonpolyposis colon cancer screening in a
32 year old man%

a.father, paternal ant and paternal cosin with colon cancer with ages of diagnosis of 54, /:, 37 years, respectively
!. ,nnmera!le polyps visaliAed on rotine colonoscopy
c. 8coctaneos pigmentation
d. *ew diagnosis of Hlcerative colitis
e. *one of the a!ove

4. A 30 year old woman presents to r office complaining of parasthesias, wea"ness. <ac" of coordination, and
difficlty with gait. )er symptoms are worse after a hot shower. &$amination of the '6> shows oligoclonal !ands of
,g(. -he most li"ely diagnosis is:

a. 8ltipe 6clerosis
!. )ntingtonOs disease
c. Par"insonOs disease
d. *erofi!romatosis
e. Amyotrophic lateral sclerosis

5. A 5/ year old, an presents with chronic diarrhea. )e stats he has loose stools for last 2 days. *o !lood in stool,
temperatre, weight loss or recent travel. Hr ne$t step:

a. 5!servation
!. 6tool cltre
c. 'olonoscopy
d. 6tool fat stdies

/. A 72 years old female with severe osteoporosis presents for evalation of shortness of !reath. 6he is a lifetime
nonsmo"er and has had no e$posres. 5n physical e$amination yo note "yphoscoliosis.
All the following plmonary a!normalities are e$pected e$cept:

a. 2estrictive lng disease
!. Alveolar hypoventilation
c. 5!strctive lng disease
d. 9entilation B perfsion a!normalities with hypo$emia
e. Plmonary hypertension

7. A 23 years old male is clim!ing 8ont .iliman0aro. )e has no medical pro!lems and ta"es no medicine. 6hortly
after !eginning the clim!. )e develops severe shortness of !reath. Physical e$amination shows diffse !ilateral
inspiratory crac"les. #hich of the following is most li"ely etiology%

a. Acte intestinal pnemonitis
!. Acte respiratory distress syndrome
c. 'ardiogenic shoc"
d. 'ommnity ac7ired pnemonia
e. )igh altitde plmonary edema

:. #hich of the following se7ences represents how a typical anteroseptal myocardial infarction progresses on &'(%

a. IB wave development, pea"ed - waves, 6- segment elevation, - wave inversion
!. - wave inversion, IB wave development, 6- segment elevation, pea"ed - waves
c. pea"ed - waves, 6- segment elevation, IB wave development, - wave inversion
d. pea"ed - waves, IB wave development, 6- segment elevation, - wave inversion
e. 6- segment elevation, - wave inversion, IB wave development, pea"ed - waves

3. A 5: year old secretary presents with asthenia and hyperpigmented changes on her
el!ow and inner chee". 6he also had noted het !lood pressre is low and she is diAAy
when she stands. 6he has also lost 5 "g and has some no nasea and no vomiting. A
recent test for coccidiomycosis was positive. Appropriate testing this time incldes:

a. '- of the a!domen
!. &sophagododenoscopy
c. (lcose tolerance test
d. A'-) stimlation test
e. 'olonoscopy

10. #hich of the following statements a!ot polycythemia vera is tre%

a. ,tOs a chronic myeloproliferative disorder that is associated with increased levels of )! concentration and red !lood
cells masses =erythrocytosis?.
!.,t is associated with nerodegenerative condition of the thalams
c. Physical e$amination sally shows decreased peripheral refle$es.
d. <ecopenia and throm!ocytopenia are common.
e.-he disease is associated with an increased life span of the re !lood cells

11. #hich of the following is sed in treatment to congestive heart failre with systolic dysfnction%

a. verapamil
!. diltiaAem
c. ramipril
d. nifedipine
e. isoproterenol

12. A /5 y.o. 8an present to the hospital with shortness of !reath. )e has no prior medical care. <a!oratory is
@*P 1500 pg;l. Jo sspect%

a. asthma e$acer!ation
!. copd e$acer!ation
c. plmonary em!olism
d. +9-
e. ')>

13. #hich of the following can se to distingish atrial fltter and sins tachycardia%

a. carotid sins massage
!. administration of diltiaAem
c. administration of isoproterenol
d. temporal artery massage
e. administration of adenosine

14. )ospitaliAed patient receive !lood transfsion. -he patient is flashed, has a!dominal discomfort and
3:.4 t fever. #hat is the !est management%

a. administration of acetaminophen and to slow the transfsion rate
!. administration of diphenhydramine and contine the transfsion
c. 100mg hydrocortisone i.v. And slow transfsion rate
d. stop transfsion and increase i.v. >lid
e. i.v. 2anitidine and order a!dominal series $Bray

15. 6!clinial hypothyroidism is diagnosed with%

a. normal -4 and low -6)
!. normal -4 and high -6)
c. low -4 and high -6)
d. normal -4 and normal -6)
e. low -4 and !orderline -6)

1/. #hich of the following is e severe complication of warfarin which is nrelated to !leeding%

a. pancreatic neoplasm
!. hepatitis
c. s"in necrosis
d. peripheral neropathy
e. plmonary fi!rosis

17. A 24 y.o. 8an i.v. +rg ser present to the hospital with fever, night sweats chest pain, arthralgia, painless
erythematos lesion on the palm of his hand, rond erythematos lesions with central cleaning on the retina and
splinter hemorrhage on the finger nails. -he most li"ely diagnosis%

a. ),9
!. !acterial endocarditis
c. syphilis
d. infectios hepetitis
e. lyme disease

1:. #hich of the following is associated with '.8.<%

a. le"openia
!. philadelphia chromosome
c. elevated le"ocyte al"alosis phosphatase
d. trom!ocytopenia
e. decreased !12 levels

13. +efinition of chronic !ronchitis%

a. chronic prodctive cogh for 3 months in 2 consective years.
!. chronic prodctive cogh not responsive to anti!iotics.
c. associated with distraction of lng tisse and development of !le!s
d. chronic prodctive cogh for / months in 5 consective years.
e. redction of lng compliance of 301 or more

20. A 25 y.o. 8an present to the hospital with !ac" pain and generaliAed fatige la!oratory test shows
anemia with rolea formation, monoclonal spi"e on electrophoresis and hypercalcamia. 2adiograph of the lm!er
spine shows lytic lesions. #hat is the most pro!a!le diagnosis%

a. metastatic prostate cancer
!. paget disease
c. osteitis fi!rosa cystica
d. mltiple myeloma
e. colon cancer

24. 8itral valve prolapse =89P? is associated with:

a. &lderly, o!ese men.
!. diastolic clic" that disappears with valsalva manever.
c. 'hest pain, dyspnea and sycope.
d. rhematic heart disease.
e. my$omatos transformation of the valve leaflet.

25. A 2: year old homose$al man, complians of nonBprodctive cogh, shortness of !reath, high temperatre and
chills. chest GBray shows !ilateral interstitial infiltrates. the !est treatment wold !e:

a. 5ral aAithromycin.
!. ,9 penicillin.
c. ,9 -8PB68G.
d. ,9 amphotericin.
e. 5!servation only.

23. A / year old girl is sent home from smmer camp with a fever of 3:.5', stiff nec", photopho!ia and headache.
<P shows #@' 3:0 cells;mm3 with /51 polymorphoncleat cells and 351 lymphocytes, normal protein and glcose
level, negative gram stain. #hich pathogen is most li"ely to case her symptoms:

a. *isseria meningitidis.
!. 6trep. pnemonia.
c. &nterovirs.
d. @orrelia !rdorferi.
e. 8yco!acterim t!erclosis.

31. A 10 year Bold girl has had a cold for 14 days prior to the visit, she has developed a fever of 33T', prlent
discharge, facial pain, and daytime cogh. &$amination of the nose after topical descongestants shows ps in the
middle meats. #hich of the following is themost li"ely diagnosis%

a.!rain a!scess
!.ma$illary sinsitis
c.streptococcal throat infection
d.retrofaringeal a!scess
e.middle ear infection

32. @oy of 2 yearsBold, who developed noisy !reathingon inspiration, mar"ed retractions of the chest wall, flaring of
the nostrils , and !ar"ing cogh, )e has had mild apper respiratory infection for the past 2 days .
#hich of the following is the most li"ely diagnosis%

c. !ronchiolitis
d. viral crop
e.foreing !ody in the right !ronchs

33. ,n which of the following a 10 yearsBold patient wold isolation of psedomona Aerginosa from the sptm !e

a. 'hild with tetralogia of >allot ndergoing cardiac repair
!. 'hild with fi!rosis cystic who has moderate cogh severe lng desease
c. a previosly well child presenting with temperatre of 40T', a left lower lo!e infiltrate, and white
!lood cell cont of 20.000;m3
d. 'hild with asthma previosl nder good control, who presents with wheeAing nresponsive to !ronchiodilators
e. An adolescent who has recently !een sing hot t!

34. 2 month old child is seen at yor clinc for the first time. -he child was !orn at home , and this is the first well child
visit. 2isc" factorsfor infant !otlism that shold !e commnicated to the pearents inclde:

a. gardening
!. home constrction
c. froAen vegeta!les
d. honey
e. all of the a!ove

35. A 15 yearsBold white girl develops !loody diarrhea on the / day of hospitaliAation
for therapy of presmed !acterial nemonia.6he has recived intravenos Ampicilin.
>ever and tachipnea resolved and her o$ygenation now is normal. ,n fact, she was
schedled for discharge. #hich of the following action wold !e most apropiate%

a. 6wicht tha anti!iotic to 3erd generarion cephalosporines
!. +iscontine Ampiciline
c. 5!tain ventilation Bperfsion scan
d. 5!tain '- scan of the a!domen
e. Add erythromycin or do$ycyline

3/. *ew!orn develops sepsis and shoc" , the pathogen that most commonly cases systemic and focal infection
in new!orn is :

aBstaphylococcs Ares
!B grop A streptococci
cBgrop @ streptococci
dBeschearichia coli
eBherpe$ simple$ virs

37. #hich of the following tmors is associated with &pstein B@arr virs infection

a. .aposi sarcoma
!. @r"it lynphoma
c. nero!lastoma
d. wilmOs tmor
e. 'arcinoma of colon

3:. #hich of the following cancers occrs primarity dring childhood%

a. @reast cancer
!. 2enal cell cancer
c. #ilmOs tmor
d. Prostate cancer
e. 'olon cancer

33. A 4 yearB old !oy with anemia has a !one marrow !iopsy that shows 41 !lasts . *o !lasts are seen on
peripheral !lood smear. >inding on physical e$amination and another stdios are normal. 8ost li"ely diagnosis%

a. Acte <ympho!lastic le"emia
!. Acte myelogenos le"emia
c. chronic myelogenos le"emia
d. prele"emia 6yndrome
e. this is a normal !one marrow !iopsy

40. 8ost important e$tramedllary site of relapse in childhood acte lypho!lastic le"emia =A<<?:

a. Adrenal glands
!. .idney
c. )eart
d. <ng
e. 'entral nervos system

41. -he developmental appropriate age of child who scri!!les, wal"s alone, spea"s one real word and pretends to
drin" from a cp is:

a. 7 months.
!. 13 months.
c. 20 months.
d. 24 months.
e. 30 months.

42. -he developmental appropriate age of child who rolls !ac" to front, has a thm! finger grasp, self inhi!its to
UnoU and !angs two c!s is:

a. : months.
!. 12 months.
c. 15 months.
d. 3 months.
e. 1: months.

43. A 10 years old girl has had diplopia, ptosis and wea"ness of her nec" fle$ors for 2 months. 6ymptoms are
worse in the evening and sally less severe awa"ing on the morning. *o fasciclation or myalgia, her deep tendon
refle$es are normal. -he most li"ely diagnosis:

a. )ysterical wea"ness.
!. 8scle dystrophy.
c. 6pinal msclar atrophy.
d. @otlism.
e. 8yasthenia (ravis.

44. A 4 year old !oy is evalated for his first generaliAed tonicBclonic seiAre which lasted 10min. *o history of
illness or fever and findings on e$amination after the seiAre are completely normal. -he most appropriate
management is:

a. @egin therapy with 'ar!amaAepine.
!. 5rder &&(.
c. 5rder '- scanner of the !rain.
d. 5rder 82, of the !rain.
e. 5rder psychometric testing.

45. A 15 months old girl is evalated for a 10 min long generaliAed seiAre associated with a temperatre of 40V'.
#hich of the following factors in the list is most li"ely to increase the ris" of ftre seiAers%

a. Apgar 3B5.
!. >amily history of epilepsy.
c. 'linical evidence of roseola.
d. >emale gender.
e. Presence of 2Bcaf a lait spots.

4/. A 3 months old infant presents for a wellBchild evalation. #hich of the following complaints wold !e a case
of concern%

a. 2egrgitation of 15B30ml formla 3 times a day.
!. 5ne !owel movement every other day.
c. -hree !owel movements per day.
d. <iver edge palpa!le 2 cm !elow the right costal margin.
e. )emoccltBpositive stool.

47. A 3 years old hearing impaired child playing with his hearing aid. *o !attery can !e fond, and the child is
noted to !e drooling. -he most appropriate ne$t step in treatment wold !e:

a. &nsring consmption of flids.
!. ,pecac administration.
c. Activated charcoal administration.
d. 'hest and a!dominal GBray stdies.
e. 5!servation and follow p in 24hors.

4:. *ose!leeds in children arise most commonly from:

a. -r!inates.
!. *asopharyn$.
c. Post septm.
d. .iessel!achs ple$s =ant septm?.
e. 8a$illary sins.

43. A 30 mintes old term 3B4"g !a!y !orn of spontaneos vaginal delivery is noted to have acrocyanosis.
8ost important ne$t step:

a. Perform a sepsis evalation.
!. Perform a '@' followed !y a sepsis wor" p if netropenia is fond.
c. .eep infant warm.
d. @egin o$ygen administration.
e. )old oral feedings ntil acrocyanosis resolves.

50. @ilateral and mltiple retinal hemorrhages, presenting in the si$th wea" of life in a previosly normal lethargic
neonate, withot any other physical fonding. Are most li"ely de to:

a. @irth trama.
!. *chal cord.
c. 9acm e$tract.
d. @eing large for gest age.
e. 'hild a!se.

51. 9ery low !irth weight W1500 gr infants are !est descri!ed :

a. predominantly growth restricted
!. predominantly prematre
c. predominantly post dates
d. the reslt of maternal illness
e. the reslt of placental infarction

52. A 3 year old !oy presents to yor office with sdden onset of cola colored rine
progressive facial swelling over the past 3 days, and decreased rine volme over the
past day. 5n e$amination: !lood pressre 130;:0 mm)g, perior!ital edema, !i!asilar
rales, and an"le swelling. )is rinalysis is remar"a!le for 3E hematria, 1E proteinria, 100 red !lood cells, and red
!lood cell casts, his serm electrolytes are normal and the serm al!min is 3.2 g;l.
this clinical presentation is most consistent with:

a. acte renal failre
!. acte pyelonephritis
c. nephrotic syndrome
d. acte glomerlonephritis
e. chronic renal failre

53. A 3 year old !oy presents to an rgent care clinic with a 3 day history of a!dominal pain and difficlty wal"ing.
A!normal findings inclde !lood pressre of 120;:0 mm)g diffse a!dominal tenderness. Prpric rash of the hands
and an"les and diffse periarticlar tenderness and swelling of the an"les. -he most li"ely diagnosis is :

a. systemic lps erytimatosis
!. .awasa"iOs disease
c. 0venile rhematoid arthritis
d. henochBschonlein prpra
e. stevens 0honson syndrome

54. A 3 year old girl presents acte onset of lethargy and pallor the child has !loody diarrhea for 5 days that
cleared one day prior to presenting to yor office, she also notes acte onset of cola colored rine. 5n
e$amination the patient is pale and lethargic pressre 120;:0 mm)g. -he most appropriate ne$t step:

a. rinalysis
!. $ ray of the a!domen
c. midstream rine cltre
d. !lood cell cont and smear
e. prothrom!ine time

55. 1 month female infant is presented with chief complaint of poor feeding and lethargy, the parents report that the
child was well ntil 3 days earlier when poor feeding !egan plse rate is 2:0 !eats;min, respiratory rate is 50;min
!lood pressre is :0;50 mm)g. Physical e$amination shows a gallop rhythm and an enlarged liver palpa!le 2B3 cm
!elow the right costal margin. -he most appropriate diagnostic test for this patient wold !e:

a. chest radiograph
!. '@' complete !lood cont
c. &'(
d. arterial !lood gases
e. !lood cltre

5/. 2 month old infant with spraventriclar tachycardia a initial management:

a. vagal stimlation
!. cardioversion
c. defi!rillation
d. digitaliAation
e. intravenos verapamil

57. A previosly healthy 7 year old girl has a 3Bw" history of fever, myalgias, and appositive !lood cltre for
staphylococcs ares . the past medical history is negative inclding a normal camp physical e$amination /Bmo ago,
which did not reveal any heart mrmr. After repeating a !lood cltre, the ne$t step in her evalation shold !e:

a.chest radiograph
!.complete !lood cont
c. echocardiogram
d. !one scan
e. dental clinic appointment

5:. -he most fre7ent presenting manifestations of pheochromocytoma in children is :

a. night mares
!. a!dominal pain
c. polyria and polydipsia
d. weight loss
e. hypertension

53. A 7 day is admitted to the hospital for evalation of vomiting and dehydration, physical e$amination is normal
e$cept for minimal hyperpigmentation of the nipples. 6erm sodim and potassim concentrations are 120
me7;l =low? and 3 me7;l =high?, respectively. #hich of the following is the most li"ely diagnosis :

a. pyloric stenosis
!. congenital adrenal hyperplasia
c. secondary hypothyroidism
d. panhypopititarism
e. hyperaldosteronism

/0. A /Bw" has gained no weight since !irth. )er s"in appears mottled, and an indirect !ilir!in level is measred at
15 mg;dl =high? her e$tremities are cold and her temp. is 35c, the most li"ely diagnosis is:

a. "ernicters
!. sepsis
c. galctosemia
d. hypothermia
e. hypothyroidism

/1. A 12 years 0ewish girl sffer from anemia , le"openia ,thrompocytopenia, large spleen on $Bray femr show
erlenm eyer flas", a!normal !one marrow the most li"ley diagnosis%

a. tayBsachs disease
!. gncher disease
c. mcopolysaccheridosis
d. canavan disease
e. glycogen storage disease

/2. -he disease pass throgh mother affect sons and daghter in varia!le manifestation in affect si!ling. most li"ely %

a. mitochondrial inheritance
!. mltifactorial inheritance
c. $Blin"ed recessive inheritance
d. atosomal rcessive
e. enviromentaly indce

/3. 2A6- determinds%

a. !ronchial reactivity serotonin
!.!ronchial reactivity after inhalation !ronchial provocation test
c.the proportion to the allergic immnoglo!ilin
d. antigen specific serm ige concentration
e.overal allergic ris" profile !ased on a!solte eosinophil , total ige and s"in test

/4. A 12 years !oy complain from sneeAing, clear rhinorrhea , itching physical e$am reveals !oggy pale nasal
edema clear discharge most li"ely diagnosis %

a. foreign !ody
!. vasomotor rhinitis
c. netrophilic rhinitis
d. nasal mastocytosis
e. allergic rhinitis

/5. 3 year old female pt. coghing and wheeAing what the strong ris" factor for persistent asthma in toddler
with recrrent wheeAing%

a. ecAema
!. colic
c. living on farm
d. female gender
e. 58 with effsion

//. #hat the effective screening test for - cell fnction%

a.a!solt lymphocyte cont
!. flow cytometry for '+4 =helper? E '+: =cytoto$ic?
c. respiratory !rst assey
d. candida s"in test
e. mmp A@ titer after mmps vaccination

/7. ,nfection typical to pt. with celllar immnodeficiency%

a. plasmodim viva$
!. strep. Pnemonia
c. staphy. Ares
d. pnemocytocysitis carini pnemonia
e. hemephils inflenAa

/:. 4 year white female pt. 0oint swelling with mltiple 0oint for / month slow to move in morning , move as if
stiff for first hor of day , very active child , *o rash very little limitation of range motion , &62X 4 what the
diagnostic %

a. hypermo!ility syndrome
!. +ermatomyositis
c. 6<&
d. P2A
e. )6P

/3. 'omponent of diagnostic criteria 6<& in children %

a. le"ocytosis =more 15000 #@'?
!. persistent proteinria
c. s!ctaneos nodle
d. falseBpositive heterophile test
e. erosive arthritis involving two or more peripheral 0oint

70. *ew!orn , congenital heart !loc", most li"e etiology %

a. (@ strep.
!. neonatal &chovirs infection
c. gestational +8
d. maternal lps
e. gray !a!y syndrome

71. 2egarding resscitative efforts in child, the most important goal is:

a.2estoration of ageBappropriate heart rate.
!.Appropriate movement of the chest wall.
c.Ascltation of e7al !reath sonds in !oth lngs field.
d.Ade7ate o$ygen delivery and tiliAation for the !ody tisses.
e.Palpation of e7al plses in all for e$tremities.

72. #hich statement is tre relative to childhood atopic dermatitis%

a.-he prevalence of atopic dermatitis is decreasing.
!.,tCs sally cased !y dietary protein allergy.
c.-he condition sally improves !y age 5 years.
d.Atopic dermatitis is associated with dry s"in.
e.Atopic dermatitis is sally asymptomatic.

73. A 2 day old wellBappearing fll term white neonate e$perience mltiple firm,
yellowBwhite, 1 B to 2 mm pples or pastles with a srronding erythematos flare
on the trn". wright strain of the lesion shows nmeros eosinophils. -he most li"ely diagnosis:

a.&rythema to$icm.
!.Pstlar melanosis.
d.&osinophilic pstlar folliclitis.
e.)erpes simple$ virs infection.

74. A 2Byear old !oy is noted to !e drin"ing from a container filled with "erosene. )e immediately coghs,
!ecomes tachypnic, and is !roght to the hospital. -he !est approach to his treatment is to:

a.,ndce emesis.
!.Perform nasogastric t!e lavage.
c.,nstill mineral oil.
d.Administer steroids.
e.*one of the a!ove.

75. A Previosly healthy 5 monthsBold infant develops !ronchiolitis. 5n the forth day of illness she is noted to have
!lging, opa7e, white ear drms !ilaterally. which of the following treatment regimens is the most appropriate to

a.)igh dose oral amo$cillin.
!.,ntramsclar 'eftria$one.
c.5ral 'efi$ime.
d.*o initial anti!iotic treatment.
e.5ral aAithromycin.

7/. -he se of which of the following medications is limited !y patentally lifeBthreatening rashes%


77. Hrges of implses for repetitive intentional !ehavior performed in a serotyped manner in an attempt to
relieve an$iety is termed:


7:. #hich of the following is the greatest ris" factor of sicide%

!.6ingle stats.
c.<ow income stats.
d.2esident of r!an area.
e.)istory of admission to a psychiatric hospital.

73. ,n a dying patient, which of the following is sed to detect depression%

a.Pervasive hopelessness.
!.#eight loss.
e.'oncern over !eing a !rden.

:0. #hich of the following electrolyte a!normalities is associated with !limic patients%

a.8eta!olic acidosis.
!.2espiratory acidosis.
c.8eta!olic al"alosis.
d.2espiratory al"alosis.
e.*ormal electrolytes.

:1. A 42 year old man is seen in yor office.he has recently seen a psychiatrist and is !eing treated for severe
depression.the patient cannot recall the medication that he is ta"ing,!t he remem!ers that the psychiatrist told him
not to eat cheeses or aged meats.which of the following agents is this patient most li"ely ta"ing%

a. tricyclic antidepressant
!. ssri
c. mao inhi!itor
d. neroleptic
e. an$iolytic

:2. )igh fever,tachycardia,tachypnea,diaphoresis,hypertension and seiAers develop in a psychiatric patient who
receiving haloperidol.the most li"ely diagnosis is:

a. malignant hyperthermia
!. rha!domyolysis
c. neroleptic malignant syndrome
d. sepsis
e. serotonin syndrome

:3. #hich of the following is most li"ely to case withdrawal symptoms with a!rpt discontination%

a. flo$etine =proAac?
!. sertraline =Aoloft?
c. paro$etine=pa$il?
d. citalopram=cele$a?
e. none of the ssriOs case withdrawal symptoms

:4. 'hildren who e$hi!it symptoms of school avoidance with nasea, vomiting and a!dominal pain may !enefit from:

a. antidepressent medication
!. 8ethylphenidate
c. Psychotherapy
d. !eAodiaAepines
e. 8ood sta!iliAers

:5. #hich of the following statements a!ot somatiAation disorder is tre%

a. men are more affected than women.
!. Patients e$hi!it mltiple physical comlaints that sally have an identifia!le physiologic !asis
c. -he condition sally develops after age 50.
d. 6ymptoms rarely affect the patientOs interpersonal relationships.
e. -reatment involves fre7ent office visits and reassreance to the patient.

:/. #hich of the following statements a!ot sicide is tre%

a. 8ales ma"e more sicide attempts
!. #omen are more sccsessfl
c. An$iety is the most common contri!ting factor
d. 8ost sicides occr dring decem!er
e. 8arried people have the lowest ris" for sicide

:7. (alactorrhea is associated with which of the following medications%

a. !enAodiaAepines
!. tricycle antidepressants
c. 8ao inhi!itors
d.antipsychotic medication
e. +opamine agonist

::. #hich of the following is most commonly associated with tricyclic antidepressant to$icity%

a. 3rd degree A9 !loc"
!. P2 interval prolongation
c. I- interval prolongation
d. #idened I-
e. - elevation

:3. A 25 year old male was hospitaliAed for his first episode of psychosis, started on haloperidol. After 3 days
patientOs pper !ody was contracting, he is in pain and is frightened. #hat is the !est medication to help relieve
his sffering%

a. Propranolol
!. 5lanAepin
c. Ietiapine
d. @enAtropine
e. 2isperidone

30. 8ost common type of o!session in patients with 5'+%

a. #orries a!ot contamination
!. ,ntrsive se$al thoghts
c. 2eligios o!sessions
d. )oarding
e. Preoccpation with !ody image

31. A 1: yrs single man recently diagnosed with schiAophrenia referred for consltation was recently fired from his 0o!
at afast food restarant,clinical pictres has !een dominated !y positive symptomatology,his cosin recently
diagnosed with schiAophrenia,patient as"ing a!ot his prognosis,good prognosis in his case%

a. predominant to symptom
!. yong age at onset
c. family history of schiAophrenia
d. !iAarre delsion
e. poor premor!id psychosoied fnctioning

32. A 74 yr women with history of Par"inson disease refered for psychiatric consltation de to worsening psychotic
symptom,acomplete medical wor"p failed to find any organic etiology for her adiotry hallcination and paranoid
delsion,which of the following anti pschotic appropriate in treating patient symptom%

a. haloperidol
!. respiridone
c. 7etiapine
d. Aiprasidone
e. perphenaAine

33. -he most common location of imagined defect in !ody dysmorphic disorder%

a. stomach and waist
!. !reast and genitals
c. arms and legs
d. face and hair
e. nec" and sholder

34. #hich of the following most appropriate step in initial management of patient with neroleptic malignant
disorder =*86?%

a. hydration,cooling !lan"et,cardiac and renal fnction monitoring
!. cooling !lan"et,dialysis,hydration,cardiac monitoring
c. hydration,administer !aclofen ,9,restraints,cardiac monitoring
d. administer loraAepam ,9,hydration,measre rine otpt.
e. adminster diphenhydramine ,9,cooling !lanc"et,cardiac monitoring

35. According to data from =*,)8? clinical anti psychotic trials effectiveness
stdy, which one where patient least to discontine de to lac" of efficacy%

a. olaAipine
!. 7etiapine
c. Aiprasidone
d. risperidone
e. pephenaAine

3/. 2egarding se of 662,s for the treatment of 5'+%

a. the starting dose for 5'+ ,6 <&66 than the starting dose for depression
!. target symptom worsen !efor theyimprove once treatment with 662, is started
c. the maintenance dose for 5'+ may !e higher than maintenance dose for depression
d. the onset of response is 7ic"er in 5'+ than in depression
e. if the patient fails to respond to one 662, they will fail to respond to all 662,

37. @elief in clairvoyance and telepathy fall in the list of diagnostic of which of the following%

a. histrionic personality disorder
!. schiAoid personality disorder
c. schiAotypal personality disorder
d. narcissistic personality disorder
e. paranoid personality disorder

3:. -he !est indicator for increased ris" of sicide%

a. alcohol dependence
!. marriage
c. schiAophrenia
d. previos sicidal !ehavior
e. ma0or depressive disorder

33. A 30 year old man with history of !ipolar disorder on com!ination of drgs, present wit fever, headache, hac"ing
cogh, this progress to a spreading red rash, which of the following most li"ely to have cased this condition%

a. lamotrigine and valporic acid
!. fl$etine and valporic acid
c. lamotrigine and fl$etine
d. lithm and lamotrigine
e. lithim and valporic acid

100. A 75 yr women widow leaves her home for annal vication in florida,she forget to ta"e her medication,2 days
later develop= tremor,sweating,nasea,increase an$iety?,does not se alcohol or street drg,cessation of which most
case her symptom%

a. loraAepam!
!. lithim
3. !spirone
d. traAodone
e. valporate

102. #hich one of the following disorders is most often comor!ide with anore$ia nervosa %

a. +epression
!. 5'+
c. 6ocial pho!ia
d. schiAophrenia
e. Avoidant personality disorder

104. A 12 year old !oy performs a 3 hor of daily complsive hand washing and has e$treme difficlty going to
school de to contamination fear. most appropriate treatment:

a. ,nterpersonal, cognitive or psychodynamic therapy pls flo$etine.
!. 2esponse prevention pls sertraline.
c. 6ocial s"ill grop pls methylphenidate.
d. desmopressin =++A9P? nasal spray pls !ehavioral conditioning.
e. >amily therapy.

105. #hich of these s!stances is most li"ely a!sed !y adolescents%

a. 8ari0ana
!. Alcohol
c. 'ocaine
d. &cstasy
e. <'+

107. #hich of the following is common in the childhood history of patients with !orderline personality disorder%

a. 6hyness
!. Psychosis
c. 'ondct disorder
d. 6e$al a!se
e. 8agical S odd !eliefs

110. )ypothyrodism in the eldery may commonly present with all of the following e$cept%
a. lassitde
!. fatige
c. cognitive impairment
d. anore$ia
e. constipation

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